DHA Case No. CWA 218425 (Wis. Div. Hearings and Appeals Aug. 11, 2025) (DHS) ↓ Download PDF Prevocational services may be funded through IRIS, but the participant must have a goal of community-integrated employment. In this case, the petitioner received prevocational services for three years as part of his IRIS budget (and it appears he […] Read more

DHA Case No. CWA 218446 (Wis. Div. Hearings and Appeals Jul. 17, 2025) (DHS) ↓ Download PDF A participant in IRIS may be disenrolled if they lose their Medicaid eligibility after a renewal. In this case, the petitioner completed a FoodShare renewal that the agency mistakenly processed as a Medicaid renewal, even though her Medicaid […] Read more

DHA Case No. CWA 217836 (Wis. Div. Hearings and Appeals Jul. 1, 2025) (DHS) ↓ Download PDF An IRIS participant may be involuntarily disenrolled for mismanagement of budget authority or employer authority. In this case, the petitioner was disenrolled because his family caregivers continually billed excess hours for supportive home care, overspending his budget by […] Read more

DHA Case No. CWA 217841 (Wis. Div. Hearings and Appeals Jun. 27, 2025) (DHS) ↓ Download PDF IRIS participants may submit one-time expense requests to pay for goods or services, including adaptive aids such as vehicle modifications. In this case, the petitioner requested a wheelchair conversion for a new SUV, which TMG denied as not […] Read more

DHA Case No. CWA 217818 (Wis. Div. Hearings and Appeals Jun. 17, 2025) (DHS) ↓ Download PDF Aperson enrolled in IRIS is required to pay a cost share as a condition of eligibility. In this case, the petitioner had $7,000 in unpaid cost share and was denied re-enrollment in IRIS because he was unable to […] Read more

DHA Case No. CWA 217154 (Wis. Div. Hearings and Appeals Jun. 17, 2025) (DHS) ↓ Download PDF IRIS participants may be disenrolled if they cannot or will not address health and safety concerns. In this case, the petitioner had seizures and “episodes of disorientation,” during which his caregiver would lock or barricade him in his […] Read more

DHA Case No. CWA 217677 (Wis. Div. Hearings and Appeals Jun. 9, 2025) (DHS) ↓ Download PDF To be functionally eligible for the IRIS program, an individual must require a “nursing home” level of care. In this case, the petitioner needed assistance with dressing and used adaptive equipment for bathing; he also needed assistance with […] Read more

DHA Case No. CWA 216919 (Wis. Div. Hearings and Appeals May 30, 2025) (DHS) ↓ Download PDF An IRIS participant’s budget is based in their long-term care functional screen. In this case, the petitioner’s Supportive Home Care (SHC) hours were reduced from 22.25 to 5 hour per week, even though his most recent functional screen […] Read more

DHA Case No. CWA 217205 (Wis. Div. Hearings and Appeals May 13, 2025) (DHS) ↓ Download PDF To be functionally eligible for home and community based long term care services, an individual must require a “nursing home” level of care. In this case, the petitioner’s condition improved after a bone marrow transplant; an updated functional […] Read more

DHA Case No. CWA 216858 (Wis. Div. Hearings and Appeals May 9, 2025) (DHS) ↓ Download PDF A person is functionally eligible for IRIS if, among other criteria, the person cannot safely or appropriately perform one or more ADL and 3 or more IADLs and has cognitive impairment. In this case, the petitioner was a […] Read more

DHA Case No. CWA 216762 (Wis. Div. Hearings and Appeals Mar. 19, 2025) (DHS) ↓ Download PDF Around 2017 DHS instituted a policy that a caregiver should not be approved for more than 40 hours per week of paid services, including SHC covered by IRIS and other forms of caregiving such as personal care worker […] Read more

DHA Case No. CWA 216860 (Wis. Div. Hearings and Appeals Mar. 18, 2025) (DHS) ↓ Download PDF IRIS participants must pay their providers a “usual and customary rate.” In this case, the petitioner sought an increase in the daily rate of his adult day services provider from $157.50 to $168.50. Noting the difference between the customary […] Read more

DHA Case No. CWA 216647 (Wis. Div. Hearings and Appeals Feb. 17, 2025) (DHS) ↓ Download PDF An IRIS participant may be disenrolled if the agency is unable to ensure the participant’s health and safety. In this case, the petitioner lived with her daughter, who was also her caregiver and guardian. The petitioner eloped from […] Read more

DHA Case No. CWA 216141 (Wis. Div. Hearings and Appeals Feb. 13, 2025) (DHS) ↓ Download PDF IRIS participants may be involuntarily disenrolled for failure to spend the funds in their budget. In this case, the petitioner was repeatedly warned that her failure to spend her IRIS budget could result in disenrollment, and she ultimately […] Read more